Americans are chronically dehydrated. People who drink plenty of water have lower blood pressures. 1 Many people suffer from high blood pressure; the cause of which is inadequate consumption of water. Constant dehydration forces the body to tighten the blood vessels and speed up the heart to maintain adequate blood flow to the brain and over time hypertension results. 2 Not all hypertension is the result of not drinking enough water, but more of it arises from this cause than is realized.

Contrast the impact of this “national water shortage” with the National Institute of Health’s (NIH) guidelines for treatment of hypertension. 3 Let’s say your water intake has been dismally inadequate and your brain is crying for better blood supply. The body responds with a faster heartbeat and tighter blood vessels to squeeze the blood more effectively up to the top of your head. 4 The doctor takes your blood pressure and (of course) discovers you have blood pressure that is higher than is considered safe. In line with practice guidelines the first line treatment is a diuretic; a “water pill”. You go home, the dehydration is worse (compounded) and on a return trip to the doctor you are again discovered to be not only hypertensive, but your heart rate is up. Guidelines now recommend a beta-blocker. What does a betablocker do? Slows yours fast heart rate. With that you go home, your heart is now slow, but the brain is still crying out for blood so all the blood vessels in your body get even tighter to squeeze the remaining blood to the top of your head. Back to the doctor you go for follow up; low and behold the pressure is still up. The next recommended pill to fix the “resistant hypertension” is a calcium channel blocker. What does a calcium channel blocker do? It relaxes all the blood vessel in your body. You mean the ones that tightened up to get the blood to the top of my head? Yes. Now I must hand it to the NIH, the first line therapy is really supposed to be lifestyle modifications, but in my estimation the modifications listed and the extent to which they are applied or encouraged lacks enthusiasm. Okay, so, you can see that I am not “real big” on treating diseases you get from poor lifestyle practices with any other thing than correct lifestyle practices.

Save The Brain

People with normal blood pressure live longer, 5 , 6 , 7 and what’s more, their thinking is clearer. Studying the brains of people with high blood pressure, also called hypertension, researchers have discovered an association between hypertension, brain white matter defects, and difficulty thinking and remembering. 8 People with high blood pressure develop white matter lesions in their brains at ten (10) times the rate of the normal population. 9 Controlling blood pressure with medications does not stop brain deterioration. Some blood pressure medications make the brain deteriorate even faster. 10 In order to stop brain deterioration, lifestyle habits responsible for both hypertension and dementia need to be addressed.

“Safe” Magic Potions?

Some people are quick to look to alternative medicine for a magic potion to fix their lifestyle related diseases, thinking they will find a safer cure in supplements, herbs, or vitamins. Some of these over-thecounter pills contain agents with pharmacological action just like medications, but does it make any sense to take magic potions to treat disease while continuing to practice the lifestyle habits that cause the illness in the first place? It’s not that people have not found benefit from some of these pills. Agents with some evidence of benefit include coenzyme Q10, fish oil, garlic, vitamin C, L-arginine, 11 grape seed extract, 12 quercetin, 13 , 14 rosemary, 15 cranberry, 16 fennel, 17 mistletoe, 18 , 19 saffron, 20 hawthorn berry 21 and valerian. 22 But none of these supplements change the reasons or causes as to why your blood pressure went up in the first place.

No Substitution

I am not against pills just because they are pills, but some pills (and supplements) have serious drawbacks. For example, people already on blood pressure pills respond more poorly to lifestyle changes. 23 They are somewhat trapped. What’s more, Parkinson’s disease is a side effect of some blood pressure medications. 24 What about Alzheimer’s? People with low to normal blood pressure are protected from brain diseases like Alzheimer's. 25 Artificial low blood pressure, with medications, does not always avert progression to dementia. 26 People whose good lifestyles give them a healthy blood pressure are much more likely to be mentally acute (sharp/bright) as they get older. 27 I recommend making a healthy lifestyle your defense against dementia, not medications.

What is Hypertension?

What is Hypertension? The National Institute of Health is clear on the classification of blood pressure. Blood pressure is recorded as systolic pressure over diastolic pressure. Systolic is a measure of the highest pressure the heart develops during its beat and diastolic is the lowest pressure when the heart is refilling with blood for another beat. Normal blood pressure goes no higher than 120/80. To go over 120/80, but no higher than 139/89 is to have pre-hypertension. Blood pressures over 139/89 are classified in two stages. Stage 1 hypertension is from 140-159/90-99. Any pressure of 160/100 or more is considered stage 2 hypertension. 3 The higher your blood pressure the higher your chances of experiencing other life threatening complications of hypertension.

Global Impact

Hypertension affects approximately 50 million people in the United States and 1 billion worldwide. 3 Fully 29% of US adults have hypertension, around 68% are taking antihypertensive medication, but only 64% of those taking medication have their blood pressure controlled. 36 Nine out of ten 55 year olds, in the United States, with normal blood pressure will develop hypertension before they die. 3

Types of Hypertension

There are two major types of high blood pressure, primary and secondary. 37 Primary blood pressure is generally considered to have an unknown cause, but as you continue to learn the facts about hypertension you will discover that most primary hypertension is lifestyle related—it is caused by our habits relating to eating, drinking and exercising. Secondary hypertension can be linked to other medical 2 diseases such as thyroid disease, kidney disease, parathyroid disease, metabolic syndrome (diabetes), etc.

The Silent Killer

High blood pressure is called “the silent killer” because the majority of people with hypertension are unaware of its presence. Nevertheless some people with hypertension do report symptoms, these can include: tiredness, sudden hot flashes, headaches, reduced energy, heart beat palpitations, sudden sweating, reduced physical performance, dizziness, shortness of breath, chest pain, sleepiness, blurred vision, tinnitus (ringing in the ears) and/or muscle tension. 38

Be Alert For Signs Of Cardiovascular Danger

Hypertension might not be so bad if it were not for all the other diseases it causes. Of these heart disease tops the list. Achieving normal blood pressure reduces the risk of congestive heart failure by 36%, 39 of coronary heart disease by 72%, and of heart attack by 75%! 40 Because hypertension is so hard on the heart, if you can reduce the blood pressure by just 20 points, you can cut the risk of heart disease in half. 3

Researchers have determined that lowering the average blood pressure in the United States by just 5 points would reduce the number of stroke deaths by 23,000 per year. 41 Further, lowering your blood pressure from 140/90 to a more normal 120/75 reduces your risk of stroke by 74%. 42 Bleeds are a common cause of stroke and can occur when an aneurysm bursts in the brain. If blood pressure is kept within normal limits, brain aneurysms are much less likely to enlarge and rupture. 43

Another study reported that normalizing blood pressure can reduce strokes by 35–40%, myocardial infarctions by 20–25% and heart failure by more than 50%. 44

Controlling blood pressure also reduces the risk of peripheral vascular disease: injury to blood vessels in your arms and legs that can lead to and physical disability. 45 Adding Insult To Injury

Hypertension can damage any part of your body because every part of your body is dependant upon blood for life. People with normal blood pressure save themselves much grief.

People with normal blood pressure can avoid the second leading cause (behind diabetes) of kidney failure. 46

A surprising consequence of high blood pressure is high cancer risk! For example, normal blood pressure decreases the risk of endometrial cancer by 70%. 47

Do you remember your last blood pressure numbers? Are you having difficulty thinking and remembering? People with hypertension are more apt to get Alzheimer’s in their latter years, a disease of the brain that affects the ability to think and remember. People with normal blood pressure have superior blood flow to their brains improving thought and memory. 48 , 49 Normal blood pressure protects you from brain deterioration especially in the frontal lobes. 50 People who do not have hypertension perform better on test of memory, attention and abstract reasoning. 51 Normal blood pressure can actually reduce the risk of Alzheimer’s by 40%. 52

Diabetes and hypertension are often closely related. When combined with low HDL cholesterol, high triglycerides and central obesity they are given a diagnosis of syndrome X. 53 Syndrome X is not a good diagnosis to have, but lifestyle interventions are most effective at treating this disease.

Osteoporosis is a thinning of the bones leading to an increased risk of fractures. People with normal blood pressure have 1/3 the risk of osteoporosis as those with hypertension. 54

Retinopathy and Macular Degeneration are leading causes of blindness. Keeping blood pressure within normal limits cuts the risk of blindness from retinopathy and/or macular degeneration in half. 55

Erectile dysfunction: the pressure in performance anxiety! Having trouble pleasing your wife? Thirty-two percent more men with normal blood pressure “get it up” than men with hypertension. 56

Where Are We Headed: Outline

Lets talk about where we are headed with our hypertension discussion. Blood pressure is a product of the pumping of the heart, the blood vessel size, blood thickness and blood volume. If the heart beats faster, more blood is pumped and the pressure goes up. We call this tachycardia. If the blood vessels tighten up, making the space for the passage of blood narrower, it takes greater pressure to get the same amount of blood through to its destination. We refer to this tightening up effect as vasoconstriction. Blood vessels normally expand with each beat of the heart and then relax. If the blood vessels become hard, their stiffness inhibits the free flow of blood with each beat of the heart and the pressure goes up. Atherosclerosis is an example of this process. If the blood becomes thick and sludgy, more pressure is required to push it through the blood vessels and hypertension commences. When blood gets thick we say that the viscosity has increased too much. If the blood vessels are being choked by something pressing on them from their sides, the effect is like putting your thumb over the end of a garden hose; this results in increased blood pressure. We call this external compression. Finally, if the volume of blood increases, this increases the amount of blood entering the heart, this in turn increases the amount of blood the heart pumps with each beat increasing the overall blood pressure. We often refer to this phenomenon as fluid retention.

Volume Overload!

Lets start by talking about the problem of volume overload. Volume overload can be the result of obesity, where it takes more blood to feed an increased mass of fat tissue. Salt causes fluid retention effectively producing volume overload. Volume overload results when the kidneys fail because the kidneys are responsible for dispensing with excess fluid volume. Muscles have many large blood vessels and require lots of blood when exercised. Big muscles left unused become stiff and their blood vessels become stiff resisting blood flow and causing volume overload at the heart. Thus inactivity leads to hypertension. Blood does not like to be cold (you are not cold blooded) and if your legs or arms are cold, the blood vessels in these extremities tighten up sending all of the blood flooding to the heart thereby overloading it and causing hypertension. 57

US Sodium Intake Exceeds Dietary Guidelines

It is a well-known fact that dietary salt plays a significant role in the evolution of hypertension. Salt causes your body to hold on to excess fluid; causing volume overload at the heart, and subsequent hypertension. It is estimated that reducing sodium intake in America to 1300mg (about ½ teaspoon of salt) per day would reduce the yearly death rate by 150,000. 58 Our recommends are that total salt consumption not exceed 1/4 to 1/8 teaspoon per day, or 600mg to 300mg of sodium total.

Salt is a popular ingredient in fast food restaurant menu items. Salt and hypertension are key ingredients for the occurrence of a brain stroke. A national statistic reveals that the more neighborhood fast food restaurants a community has, the higher will be the stroke rate in that given community. 59

Okay, so test your salt savvy: which has more sodium Rice Chex cereal or potato chips per one ounce serving each? The Rice Chex cereal at 249 mg has nearly twice as much as potato chips at 147 mg. How did you do? Lets compare tortilla chips and canned tomato sauce: The tomato sauce tops the chips at 147 mg / oz, the chips contain 118mg of sodium per ounce. What about Kraft Valveeta processed cheese or a hot dog sandwich? Ounce for ounce the Valveeta has nearly twice as much sodium at 420 mg compared to the hot dog’s 221 mg. 60 Read your labels! Don’t get caught off guard. Or, better yet, buy food without labels, like corn on the cob, which has one-tenth the sodium as canned corn. 61 In Japan, soy sauce is a significant source of excess sodium. In 3 Japan, most (63%) dietary sodium comes from soy sauce and is a big cause of hypertension. 62

Let’s suppose your sodium intake is within safe limits but you still seem to be having salt related hypertension. It may be due to other things in your diet that cause you to retain sodium. Refined carbohydrates and saturated fats increase salt retention and lead to hypertension. 63 , 64

Psychosocial factors can also affect the body’s propensity to hold on to excess sodium. People under stress retain sodium. 65 Thus, people who don’t stress out, retain less salt and have lower blood pressures. We will be revisiting this factor in detail under the fast heart rate discussion section further on in this paper.

Blood pressure raising sodium is not unique (or limited) to table salt; it also appears in sea salt and in mono sodium glutamate (MSG). It should come as no surprise then that MSG consumption increases the likelihood that a person will get high blood pressure. 66

Escalating Obesity Raises Pressure Concerns

Think twice before shopping for a larger dress: clothing size correlates directly with increases in blood pressure. 67 According to the World Health Organization, more than one billion people worldwide are overweight and more than 300 million people are obese resulting in high rates of hypertension, kidney disease and cardiovascular disease. 68 What we eat in America, the (S)tandard (A)merican (D)iet, makes the liver sick with “fatty liver disease” and triples the risk of hypertension. 69 A “pot belly” is a bad omen for hypertension. Thinner is better, tighten that belly for a drop in pressure! The more abdominal (visceral fat) you sport, the greater your risk of hypertension. 70 One serving of cheese per day can significantly increase a man’s waist circumference, body mass index and blood pressure. 71 Indeed, each inch you can tighten your belt lowers your risk of hypertension by 15%. 72 To relate it to absolute weight gain in pounds, a 55 lb weight gain over your ideal body weight raises your risk of hypertension by 265%. 73 It is estimated that in up to 50% of the adults in the United States whose hypertension is being managed with pills, the need for drug therapy could be alleviated with modest reductions in body weight. 74

Inequality Among The Protein Giants

While many see protein as essential, excessive intake has been linked to hypertension. 75 Specifically, animal protein especially decreases kidney function increasing the risk of hypertension. 76 On the other hand plant protein has been demonstrated to lower blood pressure. Increased intake of plant protein, fruits and vegetables significantly lowers the risk of hypertension. 77 As a practical example, two groups of people were compared. The first group used milk, a source of animal protein, and the second group was given soy milk, a source of vegetable protein. Those on the soy milk experienced 18 mmHg lower blood pressures than those on the cows milk. 78 What’s more a switch to soy can improve kidney function and insulin sensitivity, 79 and lowered serum total cholesterol levels. 80

Vasoconstriction

Let’s now turn our attention to the impact of vasoconstriction on the development of high blood pressure. If the blood vessels tighten up, making the space for the passage of blood narrower, it takes greater pressure to get the same amount of blood through to its destination. What makes the blood vessels tighten up? Psychological stress!, cold; especially in the arms and/or legs; failing to maintain adequate water intake and then there are the substances which stimulate the blood vessels to constrict such as caffeine from tea, coffee, colas, etc, and tobacco. Putting Pressure On: Substance Abuse

Caffeine makes the heart react as it would if you were in a real lifeor-death, stressful, flight-or-fight situation. 81 What actually happens is that caffeine acutely raises blood pressure by raising circulating concentrations of the stress mediators epinephrine and norepinephrine. In addition caffeine increases arterial stiffness and inhibits the relaxation of blood vessels. 82 The impact of caffeine consumption on blood pressure is dose dependant; the more caffeine you consume, the higher your blood pressure increases. 83

Chocolate contains caffeine as well as other similar vasoactive substances such as theobromine. 84 Some have crafted studies (which lack any disclaimer to industry involvement, funding or researcher bias) designed to give chocolate apparent positive effects on high blood pressure. 85 But in studies of real people eating chocolate available from stores it does not lower blood pressure, it only tends to encourage eating between meals and weight gain. 86

The nicotine in tobacco is also a vasoconstrictor and pressor—a substance which raises blood pressure. Non-smokers have 12% lower risk of developing hypertension than smokers. 87

Environmental Hazards

Remember the people who got sick from the FEMA trailers used to house victims of hurricane Katrina that hit Louisiana? 88 Environmental chemicals such as formaldehyde and acetaldehyde, which are found in building materials and cigarette smoke, increase hypertension tightening blood vessels and increase the amount of blood the heart pumps. 89

Vasoconstriction can be the result of electro-magnetic bombardment. For example 40 minutes on the mobile phone can raise your blood pressure by 10 points. 90 Weather and Clothing

When your arms or legs get cold the blood vessels in them tighten up to reduce the amount of blood coming to them so that you will not lose too much heat. Poorly clad, chilled extremities force blood back to the heart, doubling its work and raising blood pressure. 91 It is interesting to note that blood pressure increases in the winter, especially in the elderly, 92 but so does the consumption salt and fat. 93

On the brighter side, don’t underestimate the benefits of sunshine! Sunshine relaxes blood vessels lowering blood pressure 94 , 95 and increases vitamin D of which also has been shown to lower blood pressure. 96

Move Those Muscles!

Don’t take life sitting down! Active people have lower blood pressures; sedentary ones get hypertension. 97 Inactivity leads to increased vascular resistance to blood flow, 98 decreased blood flow to large muscles, 99 and increased blood pressure. 100 Regular use of your muscles keeps them supple and well supplied with blood, this in turn lowers blood pressure. 101 , 102

The benefits of exercise in the treatment of hypertension are often overlooked. Exercise is important for all aspects of health. If you keep wiggling, they won’t put you in a box! As a mode of exercise, walking is hard to beat. In fact, walking 10,000 steps or more per day can lower your blood pressure by 10 points. 103 That would be about 4 miles. Weight lifting or resistance training can provide additional benefit. Indeed, 20 minutes per day in the gym can lower you blood pressure by as much as 10-12 points. 104

Relaxation

Feel the need of a massage? A back massage brings relaxation and lowers blood pressure. 105 A nice soothing warm bath is also beneficial. 106

External Compression

External compression, the choking off of the blood flow by something pushing on the blood vessel from it’s outside, causes hypertension. The effect is like putting your thumb over the end of a garden hose, the result is increased blood pressure. If some one grabs your neck and chokes off your air and carotid arteries, not only will your 4 eyes bulge, but also your blood pressure will probably go up. Physical things which produce an external compression of the blood vessels include swelling or edema, inflammation, sugar coating of the vessel walls called glycation, tight clothing and obesity. Tight Clothing

Tight clothing, like belts and elastic, compress blood vessels and raise blood pressure. Clothing that hangs from your shoulders leaves your waist free of compression and aids in lowering blood pressure. Wearing loose clothes allow for more free blood flow and more normal blood pressure. 107 Instead of wearing a belt to hold up pants, suspenders are helpful to avoid the tightness.

Dickinson BD, Havas S. Reducing the population burden of cardiovascular disease by reducing sodium intake: a report of the Council on Science and Public Health. Arch Intern Med. 2007 Jul 23;167(14):1460-8.↩

Related Resources

As a physician I deem some comments not safe regarding the use of “pills”. Let patients and their doctors discuss how to manage the side effects of drugs. Remember preventive medicine is not geared towards treatments.

John Glenn Clark, M.D. and his wife Julie, and son Connor work out of Skowhegan, ME, headquarters for Northern Lights Health Education. Dr. Clark completed his training at Loma Linda University School of Medicine and now lectures on a wide variety of lifestyle related diseases and conditions.